The challenges forensic nurses face when their patient is comatose: Addressing the needs of our most vulnerable patient population

Abstract

Since 1996, the American Nurses Association has recognized forensic nursing as a formal specialty. Despite this recognition, Sexual Assault Nurse Examiners and Emergency Department nurses struggle with incorporating evidence collection into the care they give the unconscious or comatose patient they suspect has been sexually assaulted. Through case example, this article provides an abbreviated review of the circumstances under which these patients present for care, current challenges, and barriers in upholding the standard of forensic nursing care, as well as proposed interventions for the practicing forensic nurse.

Defining the boundaries: How sexual assault nurse examiners (SANEs) balance patient care and law enforcement collaboration

“…But, as the resource‐strapped legal system became more familiar with the work of forensic nurses and how their forensic skills benefited criminal investigation and prosecution, the likelihood of murky role differentiation has increased. Pierce‐Weeks and P. Campbell (2008) addressed this challenge in context of sexual assault forensic nursing:…”

Evidence Collection for the Unconscious and Unconsented Patient

“…The case for promoting the collection of evidence is primarily done with caveats, or conditions that require patient anonymity, or a provision for holding evidence until consent for release is obtained either by the patient, or a surrogate decision-maker such as a family member, guardian or judge. Pierce-Weeks and Campbell [5] argue that evidence collection has become a standard of care in the Emergency Department and to not take evidence is to fall short of that gold standard of care. They maintain that non-emergent care is routinely given along with emergent care; therefore a thorough medical/forensic examination does not violate any standards of care.…”

“…Maine's legislation incorporates an implied consent clause, and a provision granting immunity from liability for the clinician [31]. Other jurisdictions may require a search warrant to collect evidence from the unconscious patient [5].…”

Ethical Foundations for SANE Practice

“…While decisions about evidence collection should be made with the best interest of the patient in mind, creating a policy in advance allows detailed review of circumstances in order to ensure that all aspects of a patient's rights are considered, acknowledged, and protected. 43 In the state of Maine a statute recognizes implied consent for a sexual assault exam when a patient is unconscious. 44 By creating a statute to deal with the unconscious patient, the State of Maine has given nurses legal protection to collect evidence without obtaining the patient's informed consent.…”